Miscarriage

Midwives have long been the guardians of normal physiologic birth, recognizing that labor
often does not progress as efficiently and safely
when interrupted by routine procedures or unnecessary interventions.

Possible Causes of Miscarriage

Why do miscarriages happen? Unfortunately, it is rare that
we
can ever know why a miscarriage happened? For women who are
having
recurrent miscarriages, The Alan
E. Beer
Center for Reproductive Immunology & Genetics researches
and treats
couples who experience recurrent miscarriages, multiple pregnancy
losses
or repeated in vitro fertilization failures. The testing can
be expensive,
but for couples who have experienced multiple losses, they can
sometimes
identify the cause and provide therapies that reduce the chance of
a future
miscarriage.

First
Trimester Miscarriage Evaluation - [Medscape, 12/22/2011] Miscarriage is a relatively
common occurrence for otherwise healthy women. Despite its
frequency, evaluation for cause is rare. The most common cause of
miscarriage is sporadic chromosome errors. Chromosomal analysis of
the miscarriage offers an explanation in at least 50% of cases.
Conventional cytogenetic evaluation can only be done on fresh
tissue, so it is critical that the treating physician consider
genetic testing at the time of the miscarriage. Ultrasound can
estimate the gestational age at the time of miscarriage and identify
major abnormalities in some embryos. A careful pathological
examination can add to the evaluation by ruling out rare disorders
with the highest recurrence risk. A multidisciplinary approach to
miscarriage evaluation is essential to understanding the cause and
risk of recurrence. A thorough evaluation of a miscarriage, in
combination with emotional support, can often provide the necessary
reassurance and confidence as the patient prepares for her next
pregnancy.
About
Celiac Disease

Women with celiac disease suffer from an inability to digest and
absorb our nutrients properly. This can cause a miscarriage as the
baby starts getting large enough to put a strain on her body's
resources. However, women seem to be less likely to have 'classic'
symptoms of this disease, so they are less frequently diagnosed

If you have undiagnosed celiac disease and get pregnant, you're also
far more likely than a woman without the condition to experience
problems with your pregnancies. Severe anemia, threatened
miscarriage, placental abruption, gestational hypertension and
intrauterine growth restriction all occur in women with undiagnosed
celiac disease much more often than in women who don't have the
condition.

Recurrent miscarriages and/or stillbirths also may represent a
symptom of celiac disease, and several researchers recommend
screening for celiac in women with these problems. In many cases,
following the gluten-free diet after diagnosis enables women to
carry their babies to term.

Celiac disease also has been implicated in late first periods in
young women, missing menstrual periods (amenorrhea), endometriosis,
pelvic pain and early menopause, frequently in women with few or no
other celiac symptoms. - Shauna

EMF Fields

When I was pregnant with my first I had a lot of spotting, (enough
to mimic
periods) and cramping. Helped to go off caffeine but still lots of
unexplained
bleeding. This was 13 years ago. Read a blurb in Compleat Mother
about
waterbeds, electric blankets and high power lines being linked to
miscarriage,
so stopped sleeping on the waterbed. The bleeding stopped within a
weekend,
and the cramping soon after.

I've met a number of people who are pretty certain their history
of
miscarriage or infertility is related to electric blankets.

Possible Ways to Prevent Miscarriage

For a while, there was some thinking that vitamin supplementation
could
prevent miscarriage. Then this
Cochrane
review concluded that was not true:

"Authors' conclusions: Taking vitamin supplements, alone or in
combination
with other vitamins, prior to pregnancy or in early pregnancy,
does not
prevent women experiencing miscarriage or stillbirth. However,
women taking
vitamin supplements may be less likely to develop pre-eclampsia
and more
likely to have a multiple pregnancy."

I agree that taking synthetic vitamins (which is what most
pre-natals
are) would not reduce the risk of miscarriage. However,
using plant
based supplements to improve the body's ability to metabolize
essential
fatty acids - which improves the integrity of the uterine lining -
that
definitely helps. [from a Certified Nutritionist]

Progesterone

NOTE - if you had progesterone shots during pregnancy, your
uterus will
not be ready for labor when you get to term. even though your
cervix may
be very favorable. You may need to do something to help the uterus
recruit
additional oxytocin receptors so that you can have a normal,
progressive
labor. I find the best way to do this is to take cottonroot bark
tincture
. . . 1 dropperful 6 times/day once you get to 36 weeks. See
Need
for Herbal Support after Progesterone Shots

Conclusion This study found that pregnancy-related intake
of progestins
was associated with increased hypospadias
risk.

I've heard that this study is flawed in that it lumps together
synthetic
progestins (which are molecules tweaked from testosterone and
nor-testosterone)
and bio-identical progesterone(which has a different chemical
composition
and different biological effects). If you give a pregnant
women something
that displaces testosterone off its receptors, wouldn't you expect
it to
have an effect on an organism (the male fetus) that relies on
having a
normal level of testosterone to develop properly?

Stress really can lead to miscarriage [195th Meeting of the
Society
for Endocrinology; London, UK: 1-3 November, 2004]

A collection of studies on women and mice provides support for
the notion
that stress may lead to miscarriage in otherwise healthy
individuals.

My clients let me know the following day that they miss their
period.
I confirm pregnancy, put them on high dose progesterone creme,
squawvine
mixture and extremely limited work or bedrest. They take prenatal
vit/min
and a B complex. Nothing else. Habitual aborters have
carried
to term...and the babes are quite healthy.

Amen to the progest application to prevent early/repeated
miscarriages.
I have success stories too. Best results were in conjunction with
acupuncture
(to get pregnant) and when early miscarriage threatened our
client, the
acupuncturist gave her a sub-lingual wild yam. Bleeding stopped.
Healthy
term pregnancy.

Progest is expensive ($30.00 for 2 oz.). We've been making our
own progesterone
cream using tincture of wild mexican yam (Dioscorea villosa) in a
simple
pure cream or moisturizer, applied transdermally. I determine my
personal
dosage with applied kinesiology (AK) for perimenopausal and pms
symptoms.

Since becoming familiar in the early 80's with Dalton's
statistics on
the mutual associations of PMS, LPD, post-partum depression, and
"habitual"
miscarriage, I have had 4 patients with known LPD and PMS
and
"habitual" miscarriage who wished to attempt intervention at a
next pregnancy.

All four could tell me the exact date of presumed conception, and
all
four had atypical temperature graphs, with chaotic ups and downs.
All four
had barely perceptible spotting, and in each case, spotting began
on a
temperature "down."

I gave each of them 50 mg progesterone I.M. daily for 2 weeks.
All four
carried to term.

Many of you have noted that miscarriage often occurs 4-8 weeks
after
fetal demise. I propose that the ineffectiveness of progesterone
supplementation
at time of threatened miscarriage is due to the possibility that
the die
was cast in the first two weeks and that it's too late to
intervene at
the time trouble shows up. Just on opinion-- nothing to back it
up.

I wouldn't advise generalizing this story to women who don't
exhibit
the triad of PMS/LPD/habitual miscarriage, nor to those who aren't
doing
NFP/BBT monitoring of the early gestation. But within those narrow
limitations,
4/4 ain't too bad, although it might have happened anyway without
all the
fuss.

Well, your opinion has a lot of common sense behind it! I guess
the
arrangement to try progesterone should be made before conception
is attempted
-- rather than a few weeks after the missed period or positive
pregnancy
test, as it is usually done.

What do you define as "habitual" .. more than one.. more than
three?
Would you recommend progesterone after only one miscarriage if the
woman
had the other symptoms?

Wild yam is supposed to be excellent in aiding the production of
progesterone.
You can make a tea of 2 parts wild yam, 1 part black haw and 1
part cramp
bark. Another tea that might be helpful is 3 parts cramp bark, 1
part black
haw and 1 part false unicorn root.

Regarding natural progesterone--wild yam is the most popular
source.
Tea can be used, but it is very, very bitter and hard to establish
an amount.
A company called the Women's Health Connection in Oregon
manufactures the
brand of cream that we use, but there are others available in
health food
stores, etc.

As to use--is we have a client who we get to before pregnancy
begins,
we have her begin using the cream (1/4 tsp. applied externally 2
times
daily) BEFORE conception. Of course this has only happened a few
times,
but so far has been 100% successful in the habitual pattern we are
talking
about. The other clients--several (like 10-12 of them that I have
documented
in the last 2 years) call with complaints of heaviness, missed
period and
usually no morning sickness (whereas they had nausea with the
babies they
carried), and maybe cramping and/or spotting. These have been
EARLY, like
a few days to 2 weeks after missed period. They get started on the
cream
immediately and it works. The times it hasn't worked has been when
they
were farther along in their pregnancy or didn't call until a few
hours
of bright red bleeding had occurred. Hope this helps. Call
1-800-866-9085
to order the cream. It comes in 2 oz. jars. PLEASE REMEMBER TO
TELL CLIENTS
TO WEAN OFF OF IT GRADUALLY AT ABOUT 14 WEEKS, unless you do blood
tests
to verify progesterone levels. Did that answer the questions? Hope
it works
as good for you as it has for our clients (and one of my partner
midwives
used it too.)

I had a tape by Nora Tallman ND speaking at the Pacific NW Herb
Symposium
in which she says that wild yam cream applied for several months
before
pregnancy will diminish morning sickness in women who experienced
it in
previous pregnancies because it increases their progesterone. This
confuses
me because aren't high morning sickness pregnancies less likely to
miscarry?
Or is that an old wives tale?

Also interesting: Susun Weed recommends increasing progesterone
in the
last 2 weeks of the cycle to prevent miscarriage. However she says
that
taking it all the time will prevent conception. The birth control
pill
was originally made from wild yam.

This stuff about giving various doses of progesterone to a few
women,
by various routes and for various durations is all wrong. You're
using
a placebo !

There have been a number of RCTs of this and other interventions
in
recurrent miscarriage, as well as some meta-analyses. What they
all show
is that: a) doing nothing results in most women with previous
miscarriages
( even x>3 ) don't miscarry next time; and, b) none of the
pharmaceutical
interventions is better than a clinician taking a great deal of
interest
in the woman and her problem, possibly offering weekly
"reasssurance scans".

If you're interested in helping these women please do so, but
don't
waste money helping the pharmaceutical companies too.

Remember stilboestrol in the 1950's/60's ?

Could I respectfully point out that the evidence clearly shows
that
giving any form of hormonal support - hCG or prog included
(outside of
assisted conception programs) is completely ineffective. Low
progesterones
may be the result of a failing pregnancy they are certainly not a
cause.

Not that long ago everyone believed estrogens were the answer -
remember
where all that Stilbesterol got us?

Prog supplements are at best a costly placebo - at worst they may
be
harmful.

The fact that they are proven of no benefit doesn't stop folks up
here
from prescribing it like candy! even a lot of the
Naturopathic docs
prescribe if often. It's almost a fad drug.

Problem is that everyone hates to see a mom with repeated SABs
miscarry
again. We all want to do "SOMETHING to make this pregnancy
work for
her. So folks grab for the latest 'cure". Odds being what
they are,
the substance often "seems" to work -- and so we are
convinced
that it does work.

In my own time as a midwife I've seen Stibestrol (DES), thyroid
medication,
Vit E, vit B injections, chiropractic adjustments, reflexology,
aspirin,
progesterones, valium, Phenobarbital, and various and sundry
herbal
combinations come into fashion as misc. preventives. Gosh, I
even
remember a doc who was using liver infusions!

Lately wild yam seems to be the thing folks are trying.

I sure hope something works someday. I worry about this
experimentation
we are doing.

DES 'seemed" to work, even though the research was clear as early
as
the late fifties that it was not effective. That didn't stop folks
from
using it, on the basis that it "might work, and couldn't do
any harm".
And obviously there was no harm to the babies who were born. they
appeared
perfectly normal. Now, of course, we know that they were NOT
unharmed.
I hope we don't repeat that history with some of these other
"miscarriage
cures".

I agree that if a woman is a habitual aborter (had 2 in a row)
she must
start measures immediately upon finding she has missed a period.If
they
have missed 2 in a row I put them on progesterone, have them take
our miscarriage
remedy and even put them on complete bedrest until 3 weeks after
they normally
abort. When they deliver and get pregnant again, we just
have them
on the creme and the miscarriage remedy. It is a cycle and
needs
to be broken. Get the hormones in balance and most women
will deliver
term babes.

Pregnancy management for habitual aborters is a complex issue and
largely
beyond the scope of the average midwife. It is useful, however, to
have
a working understanding of pregnancy loss; There is a big
difference between
someone with a single or maybe even two non-consecutive ABs and a
"habitual
aborter" (3 or MORE); these women need to be worked up for a wide
variety
of disorders such as abnormal karyotype, thrombophilias, uterine
anomalies
and of course, hormone "imbalances". Just giving progesterone
doesn't "fix"
everyone and the odds are that sooner or later you are probably
going to
get a "good" pregnancy anyway.

The number one cause of spontaneous AB is abnormal chromosomes or
major
birth defects; this is how nature cleans house. The majority of
misses
are going to occur between 4 & 10 weeks so some kind of
heightened
surveillance in this period (or prior to conception) will be
needed if
you are going to "save" pgs.

If the mom is bleeding, I try and determine where the blood is
coming
from; I take detailed hx, examine her cervix to r/o polyps, large
ectropion,
any other obvious condition, then do an ultrasound to see if
pregnancy
is viable and whether there is bleeding/clot in the uterus; ALL
women are
advised to go on pelvic rest until 1 to 2 weeks after ALL bleeding
is resolved
(at any time in pregnancy) About 25% of early pregnancies have
spotting/bleeding
in the first trimester and half of those will miscarry for a
variety of
reason, usually the ones that also have pain/cramping. The final,
real
cause of most miscarriages will not be determined, except perhaps
in retrospect
if workup identifies a condition likely to result in recurrent AB.
I do
not believe that putting every pregnant woman who spots or bleeds
prior
to 10 weeks on progesterone is necessary or appropriate. Although
it is
expensive, I submit POC for cytogenetic analysis in women who are
habitual
aborters if they desire; we sometimes confirm abnormal chromes and
depending
on type, can look back on mom and dad.

I live in Silicon Valley, the stress-capitol of the country
(we
can all argue this I'm sure) and it is NOT going away. No matter
what I
do, stress will NOT be removed, its part of our culture. I am
continually
amazed at how much stress women try and gestate under. We have a
HUGE population
of ART patients who have had all kinds of reproductive
casualties
and most, ultimately have IVF pregnancies (many multiple) with a
majority
over the age of 40 years old. Believe me, these women are getting
everything;
progesterone, estrogen, aspirin, heparin, blood cell infusions,
you name
it. I have noted that a significant portion of the progesterone
supported
pregnancies (intravaginal application) begin spotting as a result
of cervical
irritation/inflammation but of course you have to keep "throwing"
everything
at these cases. Oh well..........placebo affect must also be
considered........

I don not have the new edition of Guide to Effective Care.... but
it
says progesterone supplements aren't effective (or no more so than
placebo)
-- except "possibly" in the very rare group of women with short
luteal
phase. Those are pretty easy to figure out -- they usually have
very short
cycles -- under 25 days.

Please respond with your up-to-date knowledge of the risks of
progesterone
therapy and the benefits in this pregnancy.

What is the benefit of beta mimetics as regards to premature
delivery
?

As for natural micronized progesterone (sthg coming from around
here)
it has the agreement for early contractions but not yet for
premature labour.
It is widely used in this country anyway in this indication, but
there
is no actual evidence of its interest. Except that the most
important is
the side effects. Patients are always sleepy. And it's difficult
to sleep
standing :-) Some people said it caused cholestasis but were never
able
to prove it.

This brings up a question I have had for sometime. There was a
brief
discussion about it 2-3 years ago on OB-Gyn-L (early in the life
of the
list) but I never saw a definitive answer. Here is the question:
What are
the effects of progesterone and estrogen on uterine perfusion? And
can
this have something to do with non-specific causes of miscarriage?
Also,
what about the effect of catecholamines like epinephrine on the
vessel
sizes and perfusion (i.e. how much could stress cause vessel
constriction
and reduction of perfusion leading to early miscarriage)? In the
mid-1980's
we published a couple of papers on sonographic measurements of the
uterine
myometrial arcuate vessel diameters and the menstrual cycle. We
could see
and measure change in the vessel diameters, with maximum dilation
coming
at mid cycle (11-17 days). We had assumed that estrogen was in
control
of the perfusion since progesterone has a later increase that did
not seem
to increase vessel size. This also seemed to be the findings of
Resnik
in sheep experiments, they also pointed out that catecholamines
reduced
perfusion. This would lead me to believe that all fertility
programs should
include deep-breathing relaxation and T-M just to maintain
perfusion until
the placenta and fetus can kick in some hormonal support. I don't
mean
to get too new age on this list, but when my wife and I
went through
a few infertility cycles (without success), it was quite
stressful. A little
like having the Gyn and the nurse in bed with us.

I have read your work. There is no question, at least from sheep
experiments,
that the myometrium and its vascular supply are affected by the
steroids
you mentioned. Progesterone to prevent miscarriage, however, has
been tested
clinically over and over, as far back as the late 50's with
absolutely
no proven advantage over placebo.

This is puzzling, isn't it, given the early work by Assali and
some
of the material published by Donald Baron's group?

This is my impression, also. However, I routinely see women (even
with
normal obstetric histories) who are followed by obtaining serial
progesterone
levels early in pregnancy. If the levels are not "appropriate"
then they
are given progesterone supplementation. This seems unfair, since
it gives
false hope to the patient, who may have an abnormal pregnancy to
begin
with (nothing like stringing along a fetus with a chromosomal
abnormality).
Although it may make some sense theoretically, I certainly can't
find data
anywhere to support it.

The practice gains some momentum from in vitro fertilization
procedures
where patients are given IM Progesterone daily for many weeks. Or
from
situations where luteal phase abnormalities are suspected of
causing early
pregnancy loss and progesterone is given to support the luteal
phase.

Although this is a completely different situation, I believe that
it's
one reason why the practice continues.

The only documented indications for progesterone therapy in the
first
trimester are it's use in patients with progesterone deficiency
(luteal
phase defects), in patients at risk to have an abnormal
estradiol/progesterone
ratio (primarily IVF patients having undergone controlled ovarian
hyperstimulation),
and in patients with no endogenous progesterone production (donor
oocyte
IVF patients, cryopreserved embryo transfer cycle patients). Even
in IVF
patients, I prefer to use hCG for luteal phase support (to
stimulate endogenous
ovarian production of progesterone) to decrease the
estradiol/progesterone
ratio if I am not concerned about increased risk of
hyperstimulation.

I do not feel there is support for it's empiric use in a patient
with
a past history of twins and premature labor.

This was my understanding. However, I frequently hear of patients
who
spontaneously conceive, have a benign pregnancy history, but have
progesterone
levels checked, and if the level is below a certain level are
prescribed
progesterone supplementation "to prevent miscarriage"! Patients
feel the
former doctor was doing something to prevent a miscarriage, and
are often
angry that their current physician is not similarly compulsive.
You just
can't win.

I'm at least pleased that the discussion has confirmed my own
conviction
that there is no point in giving progesterone in this situation.
My colleagues
that do this will admit at least privately that there is more
public relations
benefit than true medical benefit. This also brings to mind the
thread
about terbutaline and nominal premature labor and the sense that a
good
outcome somehow proves its value.

Plant Steroids

The previous subject is obviously an endless one, but as this is the
glossary
of an herbal nature, let me assure you, virtually no plants have a
direct
steroid hormone-mimicking effect. There are a few notable exceptions
with
limited application, like Cimicifuga and Licorice.

Plant steroids are usually called phytosterols, and, when they
have
any hormonal effect at all, it is usually to interfere with human
hormone
functions. Beta sitosterol, found in lots of food, interferes with
the
ability to absorb cholesterol from the diet. Corn oil and legumes
are two
well-endowed sources that can help lower chole cholesterol is
readily manufactured
in the body, and elevated cholesterol in the blood is often the
result
of internal hormone and neurologic stimulus, not the diet.
Cannabis can
act to interfere with androgenic hormones, and Taraxacum
phytosterols can
both block the synthesis of some new cholesterol by the liver and
increase
the excretion of cholesterol as bile acids; but other than that,
plants
offer little direct hormonal implication.

The first method discovered for synthesizing pharmaceutical
hormones
used a saponin, diosgenin, and a five-step chemical degradation,
and another,
using stigmasterol and bacterial culturing, to get to cortisol.
These were
chemical procedures that have nothing to do with human synthesis
of such
hormones, and the plants used for the starting materials-Mexican
Wild Yam,
Agave, and Soy were nothing more than commercially feasible
sources of
compounds widely distributed in the plant kingdom. A clever
biochemist
could obtain testosterone from potato sterols, but no one would be
likely
to make the leap of faith that eating potatoes makes you manly (or
less
womanly), and there is no reason to presume that Wild Yam
(Dioscorea) has
any progesterone effects in humans. First, the method of synthesis
from
diosgenin to progesterone has nothing to do with human synthesis
of the
corpus luteum hormone; second, oral progesterone has virtually no
effect
since it is rapidly digested; and third, orally active synthetic
progesterones
such as norethindrone are test-tube born, and never saw a Wild
Yam.

The only "precursor" the ovaries, testes and adrenal cortices
EVER need
(and the ONLY one that they can use if synthesising from scratch)
is something
almost NONE of us ever run out of...Low Density Cholesterol.
Unless you
are grimly fasting, anorectic, alcoholic, seriously ill or
training for
a triathlon, you only need blood to make steroid hormones from. If
hormones
are off, it isn't from any lack of building materials...and any
product
claiming to supply " precursors" better contain lard or butter
(they don't)...or
they are profoundly mistaken, or worse.

The recent gaggle of "Wild Yam" creams actually do contain some
Wild
Yam. (Dioscorea villosa, NOT even the old plant source of
diosgenin, D.
mexicana... if you are going to make these mistakes, at least get
the PLANT
right) This is a useful and once widely used antispasmodic
herb...I have
had great success using it for my three separate bouts with kidney
stones...until
I learned to drink more water and alkalizing teas and NEVER stay
in a hot
tub for three hours. What these various Wild Yam creams DO
contain, is
Natural Progesterone. Although this is inactive orally (oral
progesterone
is really a synthetic relative of testosterone), it IS active when
injected...or,
to a lesser degree, when applied topically. This is pharmaceutical
progesterone,
synthesized from stigmasterol, an inexpensive (soy-bean oil)
starting substance,
and, although it is identical to ovarian progesterone, it is a
completely
manufactured pharmaceutical. Taking advantage of an FDA loophole
(to them
this is only a cosmetic use...they have the misguided belief that
it is
not bioactive topically), coupled with some rather convincing (if
irregular)
studies showing the anti-osteoporotic value of topical
progesterone for
SOME women, a dozen or so manufacturers are marketing synthetic
Natural
Progesterone for topical use, yet inferring that Wild Yam is
what's doing
good.

I am not taking issue with the use of topical progesterone. It
takes
advantage of the natural slow release into the bloodstream of ANY
steroid
hormones that have been absorbed into subcutaneous adipose tissue.
It enters
the blood from general circulation the same way normal
extra-ovarian estradiol
is released, and this is philosophically (and physiologically)
preferable
to oral steroids, cagily constructed to blast on through the liver
before
it can break them down. This causes the liver to react FIRST to
the hormones,
instead of, if the source is general circulation, LAST.

My objection is both moral and herbal: the user often believes
the hormonal
effects are "natural", and that the Wild Yam somehow supplies
"precursors"
that her body can use if needed, rejected if not. This implies
self-empowerment
and the honoring of a woman's metabolic choice... something often
lacking
in medicine. This is a cheat. The creams supply a steady source of
a pharmaceutical
hormone (no precursor here) normally only available by
prescription, but
are SOLD as if the benefits come from the Wild Yam extract,
seemingly formulated
with the intent of having Wild Yam the most abundant substance so
it can
be listed first in the list of constituents. I have even seen the
pharmaceutical
Natural Progesterone labeled as "Wild Yam Proges- terone" or "Wild
Yam
Estrogen precursor" or, with utter fraud, "Wild Yam Hormone". To
my knowledge,
the use of Mexican Yam for its saponins ceased to be important by
the early
1960's, with other processes for synthesizing steroids proving to
be cheaper
and more reliable. I have been unable to find ANY manufacturer of
progesterone
that has used the old Marker Degradation Method and/or diosgenin
(from
whatever Disocorea) within the last twenty years.

Just think of it as a low-tech, noninvasive and non-prescription
source
of progesterone, applied topically and having a slow release of
moderate
amounts of the hormone. Read some of the reputable monographs on
its use,
make your choice based solely on the presence of the synthetic
hormone,
and use it or don't. It has helped some women indefinitely, for
others
it helped various symptoms for a month or two and then stopped
working,
for still other women I have talked to it caused unpleasant
symptoms until
they ceased its use. Since marketing a product means selling as
much as
possible and (understandably) presenting only the product's
positive aspects,
it would be better to try and find the parameters of "use" or
"don't use"
from articles, monographs, and best of all, other women who have
used it.
Then ask them again in a month or two and see if their personal
evaluation
has changed. If you have some bad uterine cramps, however, feel
free to
try some Wild Yam itself...it often helps.

Unless there is organic disease, hormones are off because the
whole
body is making the wrong choices in the hormones it does or
doesn't make.
It's a constitutional or metabolic or dietary or life-stress
problem, not
something akin to a lack of essential amino acids or essential
fatty acids
that will clear up if only you supply some mythic plant-derived
"precursor".
End of tirade.

Hope this info helps. The creams that contain progesterone u.s.p.
can
be used but should be monitored by a professional. Wild yam creams
without
progesterone u.s.p. are useless.

CONCLUSIONS: Treatment of early pregnancy failure with 800 microg
of
misoprostol vaginally is a safe and acceptable approach, with a
success
rate of approximately 84 percent. Copyright 2005 Massachusetts
Medical
Society.

[Summary from www.obgynworld.com] - The worldwide use of
misoprostol
for a variety of therapeutic indications in our specialty
continues to
increase. This randomized study from Vietnam compares oral and
vaginal
adminstration of the same dose (800 mcg) of misoprostol for
medical termination
of pregnancy in 200 women presenting with a confirmed missed
abortion.
Both the efficacy of the therapy and patient satisfaction was high
in both
groups, indicating that either oral or vaginal administration of
misoprostol
is appropriate for the medical management of missed abortion. The
widespread
availability of misoprostol, and its ease of storage and
administration,
may allow this drug to be especially useful to women in low
resource settings.

"Medical abortion" is the use of pharmaceuticals rather than
surgery
to empty the uterus. For women who have had a miscarriage,
having
a D&C may increase their chances of a repeat
miscarriage. A "medical
abortion" is a superior option because there's no trauma to the
cervix.

MEDICAL
ABORTION:
OVERVIEW AND MANAGEMENT - This article focuses on the
FDA-approved
regimen for medical abortion, discusses other regimens in current
clinical
use, and reviews the management of patients receiving medical
abortion
regimens. [Medscape registration is free]

Many of the herbs used to cause a miscarriage can also be used to
complete
a miscarriage and avoid unnecessary surgery that may traumatize
the uterus.
A D&C can increase the risk of future miscarriages, so many
women having
fertility difficulties may prefer to use herbs as the most
appropriate
initial treatment after miscarriage.

This info may muddy the discussion waters by introducing the drug
"methotrexate".
To help with any resulting cloudiness I offer the following:

The authors wrote:

"Methotrexate is cytotoxic to trophoblast and, in low doses, has
minimal
side effects. It is used to treat both gestational trophoblastic
meoplasia
and ectopic pregnancy. The cytotoxic effects of methotrexate on
intrauterine
trophoblasts should be equivalent."

To put this in more understandable terms: The drug methotrexate
inhibits
growth of rapidly dividing cells (ie: the egg shortly after
fertilization).
It is currently accepted for use in cases of hydatidiform molar
pregnancies
and also in tubal pregnancies. Therefore, the authors hypothesized
that
this drug would also be effective in early (as in < or = 56
days from
1st day of last menses) medical abortions.

The dosage of cytotec (misoprostol) used in these studies was 400
mcg.
The route was vaginal.

Cytotec 800 mcg (yes you read it right) intravag and repeat in 4
hours
since there is no baby there is no limit on the number of
repetitions.
It is quite normal to have 0 ctx for several applications then to
have
one or two tetanic ctx with evacuation of the POC. WATCH FOR
BLEEDING...be
ready to give pit or po methergine. Save POC and if you have
access
to an abortion facility you can have them check for completeness.

Place with as little lubricant as possible. Helps also if a
couple
of ccs of vinegar is introduced after cytotec placed. follow
by a
4x4 gauze tampon. Keep woman in bed for 30 minutes after
placing
tabs.

I seldom see big pain with this procedure except for several long
strong
ones at the end. You can do a paracervical block or use
viscous lidocaine
(lido mixed with KY) periodically as a cx massage to relieve
pain.
It is OK to use sterile water papules or a tens unit
also...but...NO Aspirin
or Motrin until the POC are evacuated.

Visualization also helps a lot....but keep it non morbid...bless
and
release the little spirit and the dreams for that child rather
than thinking
of dead tissue.

Dr. Richard U. Hausknecht of Mount Sinai School of Medicine in
New York
published a study of the use of the combination of methotrexate
and misoprostol
to induce abortion in the Aug. 31 in the New England Journal of
Medicine.

Methotrexate is FDA-approved for use against cancer; Misoprostol
is
FDA approved to treat ulcers. Because both are FDA-approved, they
can be
prescribed by physicians today and together, they produce
abortions at
a better rate than the RU-486 pill.

[from ob-gyn-l]

About Mifepristone, It is called Mifegyne in France, you can
utilize
it for abortion until 49 days of amenorrhea. You have to give 600
mg. Once
and use prostaglandins analog from 36 to 48 hours after the RU. In
the
pratique, women have to take orally RU in your presence and come
back to
clinic 2 days after, have the prosta, injection or orally. Then
often the
abortion occurs, with bleeding. She can have a antalgique. She
goes back
home accompanied, 2 hours later. It works in more than 95%. You
must verify
the vacuity of uterus maximum 9 days after. You have to give a
contraception.
Excluded to this technique, hemostat troubles, cortosurrenal
insufficiency,
people with corticotherapy. Until now, we did not propose this to
smokers.
Because of cardio-vasc problems seen with another prostaglandin
analog
on smokers. This year it seems not to be an motif of exclusion. I
think
that women who goes to this RU must be strong in her mind with the
decision
of abortion. The does all by herself so she feels completely
responsible.
Most of M.D. in France consider that it is a complication compared
to the
surgical way. Easier for us. The public hospitals goes on this
technique,
private breaks on it. RU is used to prepare cervix for surgical
abortion,
as we done before with laminaires. RU is used for Abortion
in the
second and third trimester. To prepare the cervix. It works very
well.
It is also used, in selected areas for the preparation of the
cervix on
declenchement
of post term pregnancy, normal pregnancy. But no one will say that
to you.
It is experientially done.

It has been a great product for all of us here in India. we have
been
combining the product with misoprostol for terminations up to 9
weeks as
a domiciliary therapy. Beyond up to 20 weeks we have combined it
again
as a multidose vagino-oral therapy with misoprostol. Our Success
has been
terrific with this regimen . Up to 9 weeks :

The regimen we use is called a Mifepristone with Multi-dose
Misoprostol
therapy. The key to this regimen is that once you have given 200
mg Mifepristone
on Day 1 of the therapy . On Day 2 we give no treatment until
unless they
have an bleed on that day itself in that case we treat as a day3
case.
This premature abortion occurs in around 20 % of the cases. On day
3 we
give a stat dose of 400mcg of Misoprostol orally then in 90% of
cases the
bleeding starts in about 30 mins and abortion process is completed
in about
2 hours . We then follow it up with additional 200 mcg of
misoprostol after
3 hours of the first dose. This ensures that uterus is completely
emptied
& prevents incompletes.

In case they fail to bleed within 3 hours of the first dose we
repeat
200mcg misoprostol every 3 hours till abortion process is
initiated after
which we give the final 200mcg of misoprostol to complete the
process.

I tend to agree with the view that surgical TOP is an easier
option
for T1 terminations. But the main issue here is women's choice and
an increasing
number of women in the UK chose the medical option after honest
discussions.
A lot depends on what they've heard from their peers too. In
Glasgow the
uptake is much less than in the east of Scotland where much
pioneering
work on mifepristone has been done.

As far 2nd trimester TOP and intrauterine fetal death
mifepristone is
streets ahead as far as I'm concerned. I wouldn't want a relative
of mine
treated with anything else.

I am not sure where I read this, so I cannot produce any
documentation
but maybe someone else can, but I had read that the normal time to
hold
onto a non-viable pregnancy is 4 weeks. This source said that once
we finally
lose the pregnancy that the baby has probably been dead a month.
With the
age of US we may be seeing this change a lot since D&Cs are
being done
once a dead baby is detected with a routine US. And if you think
about
it, how many times have you seen a 10 weeker miscarry a 6 week
size baby.

Some References

For all who might be interested, I dug out the references I was able
to
find on the use of misoprostol in the first trimester (none of these
papers
specifically addresses missed Ab):

"Methotrexate and misoprostol for early abortion." Family
Medicine 28(3):198-203,
1996 March.

CONCLUSION: In comparison with the five methods, the use of
extraamniotic
ethacridine, intravenous concentrated oxytocin, and balloon was
found to
provide more effective treatment than intracervical PGE2 and
misoprostol
in terms of achievement of abortion within 24 and 48 h.

There is randomized prospective study for termination using
cytotec
in the NEJM. The dosage was 200ug in the posterior fornix. I would
be very
hesitant to use 600ug for an IUFD. Unless you have been associated
with
a ruptured uterus from too much of an oxytocic and you like to
revisit
that occurrence in a new patient, use of the 200ug on a q12hr
basis works
well. If one wants to use another effective medication then
Hemabate 0.25mg
IM q2hrs will usually initiate delivery and complete it in the
IUFD population.
After the 3rd dose, the majority of patients will experience one
or more
GI side effects.

In our hospital we are using very successfully Misoprostol in
preparing
cervix after diagnosis of missed abortion. We are beginning a
randomized
study comparing Dinoprostone (Prepidil) vs. Misoprostol, bur our
previous
experience using 800 mcg (4 comp) in posterior vaginal sac leads
to spontaneous
expulsion and/or cervix ripening enough to do a very easy
curettage.

Methotrexate for Ectopic Pregnancy

There are numerous established protocols, but the most commonly used
is
Tom Stovall's protocol initially described in the late 1980's
believe the
original work was published in Fertility and Sterility.

In general, the dose is 50 mg/m2 IM and close following on hCG is
the
rule. If you have any doubts of the patient's compliance, it is
not a suitable
option.